Healthcare Provider Details

I. General information

NPI: 1609936574
Provider Name (Legal Business Name): WALTER EVERETT DIAL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 MADISON AVE
MADISON WV
25130-1669
US

IV. Provider business mailing address

50B STATE ROUTE 10
RANGER WV
25557-9712
US

V. Phone/Fax

Practice location:
  • Phone: 304-307-6070
  • Fax: 304-307-6071
Mailing address:
  • Phone: 304-369-1549
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: